Search Results (83)

Intraoperative anaesthetic monitoring is essential in rabbits due to their high perioperative morbidity and mortality and the limited availability of species-specific evidence, despite their increasing role as companion animals. This narrative review summarises the available scientific literature on intraoperative monitoring in anaesthetised rabbits, focusing on central nervous system assessment, cardiovascular and respiratory monitoring, and temperature management during general anaesthesia. Findings indicate that anaesthetic depth assessment based solely on ocular reflexes is unreliable and should be integrated with jaw tone, reflex responses, and respiratory patterns. Cardiovascular monitoring relies on heart rate, electrocardiography, and arterial pressure measurement, although invasive and non-invasive techniques have limitations in accuracy and practicability in small-size patients. Pulse oximetry and capnography assess oxygenation and ventilation but may be affected by peripheral perfusion, equipment dead space, and technical limitations. Temperature monitoring is critical due to high risk of hypothermia, with continuous or frequent measurements recommended. Overall, multimodal monitoring improves detection of physiological disturbances and supports safer anaesthetic management. Full article

Background: Designing studies to increase knowledge of the beneficial effects of volatile halogenated anaesthetics(VHAs) is critical to understand the mechanisms activated by myocardial conditioning during ischaemia-reperfusion(I/R) injury. Our research group has identified specific enzymes associated with the SAFE/RISK signalling pathways involved in halogen-induced cardioprotection and has observed a direct correlation between the expression of specific microRNA(miRNAs) and the cardioprotective effect conferred by VHA. Objective: This protocol study has been designed to increase knowledge regarding the cardioprotective effects generated by induced cardioprotective miRNAs after exposure to halogenated drugs without subjecting the patient to additional surgical procedures. Methods: The experimental design that is proposed will be performed with isogenic Wistar rats, all subjected to an I/R procedure. The animals will be randomly divided into two groups: the Donor group and the Recipient group. Half of the rats included in both groups will be exposed to sevoflurane (S), a hypnotic drug, during the I/R procedure, and the other half will be injected with propofol (P), a hypnotic. EVs will be isolated from plasma samples extracted from rats in the Donor group 24 h after the I/R procedure. In vitro EV characterisation will be performed by conducting an ultramorphological analysis, identifying the EV immunophenotype, and quantifying miRNAs. Cardiac function will be assessed by transthoracic echocardiography, histological, and immunohistochemical analyses. Results: The results derived from studies conducted according to this experimental design will support its validation as a preclinical study by regulatory authorities for approval and will serve to design a Phase I clinical trial. Conclusions: The proposed scientific rationale of applying this proposed experimental design will enable the generation of knowledge ‘from the bench to the bedside’ regarding miRNAs with cardioprotective properties induced by exposure to halogenated agents, which could be considered as biomarkers of cardioprotection. Furthermore, biomarker administration could reduce cardiac damage in patients undergoing additional cardiac surgery. Full article

Background/Objectives: Adductor canal blocks (ACBs) are widely used for postoperative analgesia following total knee arthroplasty (TKA). However, the duration of analgesia with a single-shot ACB is limited. Pharmacological adjuncts may enhance and prolong the duration of single-injection blocks, but their efficacy in this setting remains unclear. The aim of this study was to assess the analgesic effectiveness of adjuncts added to local anaesthetic for single-shot ACBs following TKA. Methods: An extensive systematic literature review was performed on Medline, Embase, CINAHL, Cochrane CENTRAL, and Web of Science. Adult patients undergoing primary TKA who received a single-shot ACB with an adjunct added to LA were eligible, with a single-shot ACB with LA alone as the comparator. The primary outcome was postoperative analgesic efficacy, assessed by pain scores (VAS/NRS), time to first rescue analgesia, total postoperative opioid consumption, or sensory block duration. Secondary outcomes included functional recovery measures and adverse events. Risk of bias was evaluated using the Cochrane RoB 2 tool, and the certainty of evidence for each adjunct–outcome combination was assessed using GRADE. Due to clinical heterogeneity, a meta-analysis was not feasible and findings were synthesised narratively. Results: Nine randomised controlled trials (RCTs) assessing the analgesic efficacy of adjuncts added to local anaesthetic in ACB following TKA were included in this review. Adjuncts included dexmedetomidine, dexamethasone, butorphanol, buprenorphine, and magnesium sulphate. Three RCTs demonstrated improvements in early postoperative analgesia with dexmedetomidine at doses of 0.5 µg/kg, while lower doses (0.25 µg/kg) did not. Dexamethasone also decreased early postoperative pain across two RCTs and showed the most evidence for significant prolongation in sensory blockade, with a dose of 4 mg needed to produce significant effects. Butorphanol and buprenorphine demonstrated a significant reduction in postoperative opioid consumption and improved pain, but evidence was limited to single trials. Findings for magnesium were inconsistent. No adjunct was associated with any serious side effect or adverse event. Conclusions: Pharmacological adjuncts added to single-shot ACBs following TKA generally improved early postoperative pain and reduced opioid consumption compared with LA alone, with the most consistent benefits observed for dexmedetomidine (0.5 µg/kg) and dexamethasone (≥4 mg). However, these effects appeared dose-dependent, were largely confined to the first 24 h after surgery, and were supported by moderate-to-low certainty evidence with limited functional outcome data. Further high-quality, adequately powered RCTs with standardised functional endpoints and longer follow-up are required to define optimal dosing, clarify safety, and determine whether improved analgesia translates into meaningful gains in rehabilitation and recovery. Full article

Background and Objectives: Recent studies suggest that remimazolam, a novel ultra-short-acting benzodiazepine, has an excellent pharmacokinetic and safety profile, favourable for ambulatory procedures. Although remimazolam has been studied as a sole agent for anaesthesia in day case gynaecological surgery, studies assessing its use in combination with other anaesthetics remain scarce. The aim of this study was to investigate the effects of a low-dose remimazolam adjunct on the characteristics of an intravenous propofol–remifentanil anaesthesia regimen. Materials and Methods: A single-centre retrospective observational cohort study was conducted on patients who underwent brief day case gynaecological surgery under general intravenous anaesthesia using remifentanil and propofol from November 2024 to January 2025. The patients were divided into two groups depending on whether they received remimazolam as an adjunct. To account for confounding, propensity scores (PSs) were estimated from baseline characteristics and used to derive stabilised inverse probability of treatment weights (IPTWs). Weighted regression models were then applied to estimate treatment effects on postoperative recovery time measures, consumption of anaesthetics, and incidence of any adverse effects intraoperatively and postoperatively. Cost effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). Results: The clinical data of 51 patients were retrospectively examined: 32 patients were assigned to the intervention group, and 19 patients were assigned to the reference group; after IPTW and PS trimming, the sum of weights was 22 in the intervention group and 58.8 in the reference group. The use of remimazolam as an adjunct was associated with 3.5 min shorter time to eye opening (p < 0.001) and 3.6 min shorter time to full consciousness (p = 0.002); the total consumption of propofol was decreased by 3 mg/kg (p < 0.001); the median dose of remimazolam adjunct was 0.12 mg/kg, or 10 mg per case. There were no statistically significant adverse effects. ICER was 2.35 € per minute of operating room (OR) time saved. Conclusions: In the setting of day case gynaecological surgery, the addition of remimazolam to a propofol–remifentanil regimen reduced propofol requirements and shortened recovery time without an increase in adverse effects. This may represent a more efficient anaesthetic approach for ambulatory procedures with a comparable safety profile. Full article

Background/Objectives: Rezum therapy is a novel, minimally invasive way of treating benign prostatic hyperplasia (BPH) that involves the injection of heated water vapour into the prostate. It was approved by NICE in 2018 and is now available in select centres across the UK. It has been shown to have significant advantages over standard BPH therapies: it can be done under local anaesthetic, making it an option for those unsuitable for general anaesthetic, it is suitable for treating patients who want to maintain ejaculation, and it is cost-effective. It has been recommended as a treatment for smaller prostates (<80cc) and in cases where patients are keen to preserve ejaculatory function. Our unit performs this procedure under local anaesthetic (LA) with a transperineal ultrasound-guided peri-prostatic block and urethral lidocaine gel in the clinic. We aimed to analyse the patients undergoing Rezum in our institution to establish its tolerability under local anaesthetic, its effectiveness and its complication rate. Methods: We analysed all patients who underwent Rezum prostate steam ablation in our institution between May 2023 and September 2025. From individual patient notes, we collected data on patient demographics, prostate size and shape, pre- and post-op IPSS and Qmax, and post-void residual. Patient-reported outcomes such as pain during the procedure and satisfaction of the procedure were also collected and analysed as well as complication rates. Results: The data of 82 patients undergoing LA Rezum in the above time period were collected and analysed. They had a mean prostate size of 53cc (minimum 21cc and maximum of 100cc). The results showed significant improvement in voiding parameters, with Qmax improving by 40.1% (p < 0.05) and PVR by 40.8% (p < 0.05). Patients similarly reported improved symptoms, with IPSS improving by 54.7% (p < 0.05) and QOL scores by 54.1% (p < 0.05). The procedure had a high degree of satisfaction, with 36 of the 49 patients who completed the post-procedure questionnaire recording an overall satisfaction of 9 or 10 out of 10. The mean intraoperative visual analogue (VAS) pain score was 3.5. Conclusions: Rezum is a minimally invasive procedure that has been seen to produce significant and reliable improvements in patients’ lower urinary tract symptoms and voiding dynamics. It has a low complication rate, is tolerated well and is readily performed under local anaesthetic in the ambulatory setting. Full article

The demand for refined anaesthetic protocols in ovine experimental surgery has increased due to ethical considerations and the need to improve perioperative stability. This study evaluated the analgesic efficacy of ultrasound-guided combined sciatic and saphenous nerve blocks using two different local anaesthetics in Hair Canarian Sheep undergoing invasive orthopaedic hindlimb surgery. Fifteen clinically healthy sheep were randomly assigned to one of three groups: lidocaine (2%), bupivacaine (0.5%), or control (general anaesthesia alone). Intraoperative physiological parameters, including heart rate, respiratory rate, and arterial blood pressure, were recorded, and postoperative pain was assessed using a modified Melbourne Pain Scale. Sheep receiving locoregional anaesthesia showed significantly lower postoperative pain scores compared with control animals. Intraoperatively, a significant difference between groups was observed only for respiratory rate, with lower values in the bupivacaine group. The bupivacaine group exhibited lower and more stable respiratory rates, with a trend towards lower heart rates during surgery, as well as consistently lower pain scores during the early postoperative period. Lidocaine provided limited intraoperative and postoperative effects compared with the control group. Respiratory rate appeared to be more closely associated with pain scores than other physiological parameters. In conclusion, ultrasound-guided sciatic and saphenous nerve blocks were associated with improved perioperative analgesia in sheep undergoing orthopaedic surgery. The use of bupivacaine was associated with lower respiratory rates intraoperatively and reduced postoperative pain scores, suggesting a potential benefit in perioperative analgesia. Full article

Aim: To undertake a prospective review to identify the intra-procedure complications in children undergoing flexible bronchoscopy with six-lobe lavage and a retrospective review to identify the rates of delayed discharge and readmission. Methods: The prospective review analysed consecutive procedures from August 2023 to August 2024 and collected data on intra-procedure and immediate post-procedure desaturations, laryngospasm, bronchospasm/wheeze, tachypnoea, pyrexia, hypothermia, and vomiting. The retrospective review analysed consecutive paediatric flexible bronchoscopies from October 2014 to August 2023 identifying discharge delays and readmissions. All children underwent flexible bronchoscopy at a single tertiary paediatric centre under general anaesthesia (GA) with a single aliquot BAL obtained from all six lobes. When cytology was required, the BAL from the right middle or most affected lobe was changed to triple aliquot. Results: Six hundred and twenty-two procedures performed on 540 children were analysed. This included 502 in the retrospective review and 120 in the prospective review. In the prospective group 4/120 (3.3%) children experienced a significant (<90%) desaturation requiring anaesthetic intervention; 11/120 (9.2%) experienced an immediate post-procedure complication such as desaturation, pyrexia, tachypnoea, wheeze, or vomiting; 53/622 (8.5%) had their discharge delayed overnight; and 13/120 (11%) children in the prospective group experienced hypothermia. A further 18/622 (3%) children re-attended hospital within 48 h of discharge. Conclusions: Flexible bronchoscopy with bronchoalveolar lavage in all six lobes under GA in children is a safe procedure with low incidence of major complications when performed by expert clinicians. Parents should be advised of a 9% risk of delayed overnight discharge. Full article

Background/Objectives: Transurethral Laser Ablation (TULA) is fast evolving as a surgical procedure, especially for small or recurrent bladder tumours. It offers a safe alternative for patients who are unsuitable for general anaesthetic (GA) or who cannot obtain timely pre-operative assessments for Transurethral Resection of Bladder Tumour (TURBT). Patients are identified for TULA in ‘Bladder Cancer Surgery Planning Meetings’ (BSPMs) and this significantly reduces their cancer waiting time (CWT). Its effectiveness as a diagnostic and therapeutic tool, including its complications and costs, has been assessed. Methods: All TULA procedures performed at the Trust were studied in two cycles. The first between August 2023 and November 2024, prior to initial audit, and then up to September 2025. Case notes, operation notes, and multidisciplinary team (MDT) outcomes were retrospectively reviewed. All procedures were performed with a flexible cystoscope and ‘cold cup’ biopsies with further ablation and haemostasis using a 1470 nm diode laser at 4 watts and 400 µm laser fibre. Patients were identified for TULA based on tumour size, location, and fitness for general anaesthetic. Results: During the study period, 95 TULA procedures were performed with a follow-up period between 4 weeks and 1 year. A total of 86 patients (90.5%) had local anaesthetic (LA) ± intravenous (IV) sedation, with 50% having LA alone in the second phase of the study; of the remaining patients, 8 had GA (8.4%) and 1 (1.1%) had spinal anaesthetic. None of the cases were considered to have missed a significant finding. One case (1.1%) was complicated, with ongoing bleeding requiring bladder washout under GA. BSPMs were introduced in July 2024 and audited in the first phase of this study. A total of 24 (39%) of patients were identified for TULA. Of those, 7 (29%) were originally scheduled for TURBT and were having difficulties obtaining pre-operative assessment (POA) clearance. Cost figures were provided by the hospital’s accountants. Conclusions: TULA has been implemented with a low complication rate and appropriate sampling. In the next phase, TULA will be rolled out to an outpatient setting, performed exclusively under LA. This will lead to a significant cost reduction. Full article

Anaesthetic-related mortality in cats is uncommon, yet concerns persist regarding potential breed predispositions and the influence of brachycephalic conformation. This study evaluated breed-specific peri-anaesthetic death before and after adjustment for American Society of Anesthesiologists (ASA) physical status. It explored whether genomic lineage or brachycephalic phenotype was associated with mortality. A prospective, multicentre cohort of general anaesthetics from 198 centres was analysed. Anaesthetic-related death was defined as death during anaesthesia or within 48 h after extubation, excluding euthanasia and deaths attributed to non-anaesthetic causes. Breeds were grouped into four genomic lineages and three brachycephalic phenotypes. Mortality proportions (Wilson 95% confidence intervals) were calculated, and relative risks (RR) were estimated using Poisson regression with robust standard errors, adjusting for ASA class. Among 14,964 cats, 94 deaths occurred (0.63%; 95% CI 0.51–0.77), with mortality increasing from 0.07% (ASA I) to 33.33% (ASA V). After ASA adjustment, most breeds did not differ from European/Domestic Shorthair cats, but Persians remained at increased risk (RR 2.22; 95% CI 1.11–4.46). Mortality did not differ between genomic lineages. Moderate brachycephaly was not associated with an increased risk, whereas brachycephalic breeds (Persian, Exotic Shorthair, Himalayan) showed a higher adjusted risk (RR = 2.33; 95% CI, 1.17–4.63). Full article

Music is considered a non-pharmacological adjunct in human anaesthesia, contributing to anaesthetic- and analgesic-sparing effects, modulating autonomic responses, and enhancing recovery. However, its effects in veterinary surgical settings remain largely unexplored. This study aimed to explore the potential influence of intraoperative music on anaesthetic and analgesic requirements, autonomic parameters, intraoperative adverse effects, and recovery quality in dogs undergoing elective ovariohysterectomy under general anaesthesia. In this prospective, randomized exploratory study, client-owned female dogs (n = 28) were randomly assigned to either a music group (exposed to instrumental classical music intraoperatively) or a control group (no music). All dogs received a standardized anaesthetic protocol. Mean end-tidal isoflurane concentrations, intraoperative analgesic requirements, heart rate, respiratory rate, blood pressure, adverse effects, and recovery quality were recorded and compared between groups using unpaired t-test, Mann–Whitney U test, or Fisher’s exact test, as appropriate (p < 0.05). No statistically significant differences were observed. Therefore, intraoperative music did not produce measurable effects on the assessed parameters. While no apparent benefit was observed in this study, future studies with larger sample sizes should investigate music-based interventions in more challenging or variable clinical scenarios. Additionally, further research is needed to clarify the extent to which anaesthetics suppress auditory processing. This exploratory investigation contributes to the limited body of evidence on auditory stimulation in veterinary anaesthesia. Full article

Background: Hip fracture surgery in elderly patients carries significant risks of both bleeding and thrombotic complications. Anaesthetists frequently face a dilemma between neuraxial anaesthesia, which may reduce thrombotic risk but is often limited by contraindications, and general anaesthesia, which is widely applicable but may exacerbate bleeding. Previous reviews have not specifically addressed bleeding and thrombotic outcomes, leaving a critical gap that this meta-analysis seeks to answer. Study objective: To evaluate the effect of neuraxial anaesthesia compared to general anaesthesia on the incidence of bleeding and thrombotic complications in acute neck of femur fracture surgery. Methods: Relevant studies comparing neuraxial and general anaesthetic for hip fracture surgery were searched for through Medline, Embase, Scopus, CINAHL and PubMed. Inclusion criteria were randomised control trials of hip fracture surgery patients aged >16 years with relevant outcome data. In total, 24 randomised control trials were included, with 5479 patients. A meta-analysis was performed using RevMan 5.4 software. The study was registered with PROSPERO ID: CRD42022348039. Outcome measurement: Primary outcomes were intra-operative blood loss, intra- or post-operative blood transfusion and post-operative deep vein thrombosis. Secondary outcomes were post-operative pulmonary embolism, post-operative myocardial infarction and post-operative stroke. Results: Neuraxial anaesthesia reduced deep vein thrombosis incidence by 45% and reduced blood loss by 58 mL, both of which reached statistical significance (p < 0.05). Albeit not reaching statistical significance, neuraxial anaesthesia also had a 35% relative risk reduction in myocardial infarction, and a 35% relative decrease in stroke in current studies published after 2010. Despite practise evolution over the decades, protective neuraxial trends have remained. Conclusions: Patients undergoing acute hip fracture surgery under general anaesthesia have higher volumes of blood loss, without requiring increased blood transfusion. General anaesthesia is also associated with higher thrombotic complications, with a 45% increased relative risk of deep vein thrombosis, compared to neuraxial anaesthesia. Multi-modal thromboprophylaxis is important, as up to a third of DVT cases occur in the non-operative leg. In frail patients with a low cardiopulmonary reserve for bleeding or in high-thrombotic-risk patients, extra consideration and optimisation for neuraxial technique is advised. Future studies on comorbidities and operation type may reveal a subgroup of patients which would benefit from a specific anaesthetic type. Full article

Purpose: As animal welfare becomes increasingly important, there is a corresponding desire to reduce the number of animals used in experiments. Recently, we reported on statistical models for a local anaesthetic simulator and developed a simulator for use in pharmacology education. In this study, we aimed to create a simulator for bioassay. Methods: Mice were intraperitoneally injected with a set concentration of lidocaine, and the time to the onset of convulsions or death was measured. Judgment times were set at 10 s intervals from 3 to 10 min. Parameter values were estimated by probit analysis based on the presence or absence of a reaction at each judgment time. The distributions and 95% confidence intervals (CI) of the estimated parameter values were confirmed using a nonparametric bootstrap method. Additionally, the generalization performance of the statistical model was confirmed using a five-fold cross-validation method. Monte Carlo simulations were performed using the estimated parameters from this model, and the average and distribution of the toxic dose 50% (TD₅₀) and lethal dose 50% (LD₅₀) were compared to those obtained from the animal experiments. Results: The parameters were properly estimated at each judgment time, and their 95% CIs were relatively narrow. The TD₅₀ and LD₅₀ values were similar across the five folds. Monte Carlo simulations demonstrated that the average and distribution of TD₅₀ and LD₅₀ were comparable to those obtained from animal experiments. Conclusions: These results suggest that a simulator based on this model is useful as an alternative to animal experiments. Therefore, our strategy will further reduce the number of experimental animals. Moreover, the method used in this study can be applied to other experiments that measure reaction time from treatment. Full article

Background: Post-operative infections are a significant cause of morbidity in patients undergoing major elective surgery. Peri-operative antibiotics are used to reduce the risk of infection. Several antibiotics modulate the host immune response. Objectives: Our objective was to determine the ex vivo immunomodulatory properties of commonly used antibiotics (amoxicillin, cefuroxime, metronidazole, or combined cefuroxime–metronidazole) on monocyte and lymphocyte phenotypes in patients undergoing major elective surgery. Methods: We performed a prospective cohort study of patients aged ≥18 years admitted to the post-anaesthetic care unit following major elective non-cardiac surgery. Peripheral blood mononuclear cells isolated immediately after surgery were incubated with antibiotics with or without a monocyte (heat-killed E. coli) or lymphocyte (CD3/CD28 beads) stimulus ex vivo. Immune cell phenotype was characterised using flow cytometry. Results: Twenty-eight patients were included. All antibiotics tested were associated with a reduction in T-cell viability, and changes to monocytes were minimal. Among CD4⁺ and CD8⁺ lymphocytes, cefuroxime increased IFN-γ (at low and high doses) and increased CD4⁺ lymphocyte IL-2 and IL-2R at higher doses. Among CD4⁺ lymphocytes, at both doses, cefuroxime increased %T_h1 population, with a parallel decrease in %T_h2, %T_h17, IL-17A, FOX-P3, and T-bet. Among the T_h1 sub-population, changes were seen at higher cefuroxime doses, including increased viability and PD-1, and a decrease in FAS, IFN-γ and CD28, and IL-7R expression. Conclusions: The choice of antibiotics directly impacts immune function following major surgery, with cefuroxime associated with ex vivo immunomodulatory effects on CD4⁺ lymphocytes. The functional implications on the development of subsequent post-operative infectious complications and long-term cancer-free survival require further investigation. Full article

Background/Objectives: Patient-reported outcome after treatment is an important factor that positively correlates with the quality of care and can influence the patient’s future health choices. Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are effective techniques for pulmonary vein isolation in patients with atrial fibrillation (AF) and have shown similar results in efficacy and safety, but they have not been thoroughly compared in terms of patient satisfaction. The aim of this study is to assess the satisfaction of paroxysmal AF patients who underwent RFA and CBA after their first procedure. Methods: Consecutive patients who underwent their first procedure of pulmonary vein isolation with RFA or CBA in eight international centres were included. A ten-point Likert scale was used for measuring patient-reported outcomes, evaluating anxiety before procedure, pain during and after ablation, motivation to repeat the procedure in future if necessary, and real and perceived procedural time. Results: A total of 483 patients were enrolled. Median age was 63 [56–69] years, and 281 (58.1%) patients were men. In total, 385 (79.7%) patients underwent RFA and 98 (20.3%) underwent CBA. RFA and CBA were equivalent in terms of the satisfaction of the patient, with the only exception being groin pain, which was lower in the CBA group (2 [0–3] vs. 3 [1–4], p = 0.002). Conscious sedation was used in 414 (86.7%) patients and general anaesthesia in 69 (14.3%) patients. The use of general anaesthesia reduced the perceived pain during and after the procedure in both techniques (p < 0.05), but it resulted in lower pre-procedural anxiety only in RFA patients compared to those under conscious sedation (4 [2–6] vs. 5 [3–7], p = 0.007). Anaesthetic management alone did not affect the willingness to repeat the procedure in RFA patients, while CBA patients under general anaesthesia were more motivated to repeat the procedure than those under conscious sedation (10 [8–10] vs. 7 [6–8], p < 0.001). The perceived procedure time was shorter than the actual time in all settings. Conclusions: Anaesthetic management seems to have a greater impact on patient-reported outcome than the technique used during ablation. Despite this, patients most motivated to repeat the procedure were those who underwent CBA under general anaesthesia. Full article

Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70–85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands. Full article